Medical Miracles Do Happen
By Priyangwada Perera
Every time we come across a child who has to undergo a liver transplant, people raise eyebrows in disbelief. “But how?”, “It is only a child!”, “How can there be liver failure?”, we have heard them question.
Similarly, if we were to say Kishanu - a young girl from a remote village in Jaffna - was diagnosed with liver disease when she was a toddler, not many would believe it. Believe it or not, it happened. With paediatric transplant unavailable in Sri Lanka and the nightmare of an amount it would cost her to fly abroad for a transplant it looked as if all hope was lost for young Kishanu. However, destiny had other plans for her.
Liver Transplant team of North Colombo Teaching Hospital (NCTH) Ragama, recently marked a special milestone with the miracle of a liver transplant performed on a Sri Lankan child. The brilliant story of success not only went down as a landmark in Sri Lankan medical history but also made Kishanu’s story a one with a happy ending.
This moment is extra special due to various reasons. Apart from being the first paediatric liver transplant, this is also the 50th liver transplant by the NCTH but most of all, it is the first ‘living-donor liver transplant’. The good news was made public in a press conference held recently at the NCTH.
Kishanu, when diagnosed with kidney disease as a mere toddler, the aetiology of her liver disease appeared to be a rare genetic one. As expected, her situation showed nothing but a gradual deterioration. Frequent ICU admissions were needed during the first year of her life. Paediatricians kept insisting on the urgent need of a transplant if she were to survive. Dr. V. Thusyanthan and Dr. K. Arulmoli from Teaching Hospital Jaffna referred Kishanu to NCTH.
Kishanu’s mother - 38 years old and healthy - was delighted to be the donor. Kishanu received a portion of her mother’s liver and both the mother and Kishnu are on road to recovery.
Kishanu’s surgical team consisted of Prof. Rohan Siriwardana who planned the surgery, Dr. Suchintha Tillakaratne, Dr. Aruna Weerasooriya, Dr. Ruwan Dissanayake and seven others, medical officers of surgical team, nursing team led by L.N. Damayanthi, P.A.M. Perera with an Anaesthetic team, and the support team.
They are thrilled at being able to have the 50th landmark and spoke of how fortunate Sri Lanka is to offer such medical services for free. Senior Professor Srirwardana re-emphasised the fact that Sri Lanka needs financial assistance with regards to these operations. “But we can assure you of the commitment, sacrifice and professional skills on our side,” Prof. Siriwardana said.
Deputy Director of North Colombo Tertiary Care Hospital /Ragama Medical Faculty Dr. Sarath Premasiri said that this liver transplant was quite a miracle. “Sometimes we cannot facilitate such surgeries with what we have. Such an operation may cost Rs 15 million abroad and here we do it completely free.” He suggested health tourism would be very profitable for Sri Lanka if we can have a tertiary care hospital for foreigners.
Dr. Meranthi Fernando, who was Kishanu’s paediatrician, had just returned with special training on children’s liver diseases from abroad. “Kishanu looked like a five-year-old, in spite of being nine years old. Her liver was in a pathetic condition. With liver problems, we have no options like dialysis. Transplanting was her only hope and none of us gave up. Doctors and the team, the parents; all had faith.”
We might understand very little about the complications of the surgery or the requirements. That is where Consultant Anaesthetist, Senior Lecturer Dr. Bhagya Gunatilleke explained what a lot is required when catering to a liver transplant. “While we handle the liver, other organs and the oxygen supply should be monitored. They should be protected from germs. We need a surgical theatre with specific instruments to stop bleeding, kidney failures or blood pressure fluctuations. We have quite a bit. Lady Ridgeway Hospital gave us some and so did some private donors. Our team gives 200 per cent.”
Dr. Gunatilleke said that the team of Anaesthetists anticipate problems, prepare for battle and expect surprises. Post-operative procedure is also overseen by them.
Head of the transplant team, Prof. Siriwardana explained the surgery. “Preparation is very important. Entire team got together and planned each step: who does what, when and how. We needed two theatres at once, one for the patient and the other for the donor. Transplant takes 12 hours. It is a very risky job. Even if you have a small slip of the hand, the patient may bleed to death. We are also dealing with a perfectly fine donor who donated about 30 per cent of her liver.” He simply explained the three steps as, “Take out, preserve and then transplant.
“In Ragama, the first surgery our team did in 2011 was with an instrument made by a local blacksmith. In our next three years, 12 out of 14 survived. The team has had doctors leaving for foreign training and some even returned to join. We have 65 per cent of a success rate. Sadly we have only a general theatre and only four to five transplants a year can be done, which is not enough. Trainees will lose touch, lose interest and fly back. That is sad. We work as a team with no seniority issues, biases or battles and give nothing but our best to the patients,” Prof. Siriwardana added.
The operation took two and a half months of preparation. “Post-operative care is crucial. I specifically thank Prof. Sajith Meththananda, who gave us Thalassemia Unit to keep Kishanu after the operation,” Dr. Fernando extended her gratitude. A successful operation means a whole new life. Apart from a small tablet Kishanu is prescribed to take regularly, her life is a one that is of a normal healthy person. However, Kishanu’s plea is, “Please help my friends.” Hopefully, many such life-giving miracles will come out of NCTH in the future.